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Women's Health > Labor - Exam 1 > Flashcards

Labor - Exam 1 Flashcards

1
Q

What is the technical definition of labor?

A

Uterine contractions that bring about demonstrable effacement and dilatation of the cervix

aka must have cervical change

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2
Q

What are the 5 components of the cervical exam when it comes to labor

A

dilation

effacement

station

consistency

position

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3
Q

What is considered completely dilated?

A

0-10cm

10cm is complete dilation

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4
Q

What is effacement? How is it measured?

A

length of the cervix (how thick it is)

Difference between the internal and external cervical os

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5
Q

What is station? How is it measured?

A

degree of descent of the presenting part of the fetus

Measured in centimeters from the ischial spines and can be measured in thirds

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6
Q

What does a firm cervical consistency equal? What are the different options? What are the different positions?

A

firm cervix means they are NOT in labor

consistency options: soft, medium and firm

position: anterior, mid position or posterior

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7
Q

In order to diagnosis labor, there MUST BE _____. What are contractions without this?

A

cervical change

Braxton Hicks contractions= contractions without cervical change

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8
Q

What is the Bishop Score? **What score is important to remember?

A

used to determine how favorable the cervix is for labor

**score>8 is favorable cervix for labor

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9
Q

Draw the Bishop Score chart

A
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10
Q

How common is the premature rupture of membranes?

A

10% of pregnancies

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11
Q

When should all mothers be screen for Group B Strep? What should you do if positive?

A

> 35 weeks all pregnant women have ano-vaginal swab

PCN before labor

alt: Erythromycin or Clindamycin or Vanc

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12
Q

Why is IV pain medication NOT used in labor?

A

Can cause nonreassuring fetal status and fetal respiratory depression

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13
Q

_____ is used for pain management during labor. Where is it placed?

A

regional anesthesia via epidural that is given as an initial bolus then a continuous infusion is started

placed in L3-4 interspace

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14
Q

What are complications with an epidural?

A

Maternal hypotension
Maternal respiratory depression
Spinal headache

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15
Q

What are the CI for epidural?

A

Maternal bleeding disorder or use of LMWH within 12h

Patient refusal

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16
Q

______ is used for pain management during a c-section

A

spinal anesthesia: one time dose directly into the spinal canal

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17
Q

when is a pudenal block used?

A

Provides perineal anesthesia

Used with operative vaginal deliveries or for extensive perineal repairs after delivery

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18
Q

When is general anesthesia used labor? What are 2 complications?

A

c section in emergent or urgent settings

maternal aspiration
risk of hypoxia to mother and fetus

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19
Q

If the pt’s Bishop score is less than 5, it may lead to _______ approximately ____ of the time. What else needs to happen?

A

failed induction

approx 50% of the time.

Bishop Score <5 indicates need for cervical ripening

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20
Q

When a pt’s labor is induced, what does it do to the latent phase of labor?

A

Latent phase of labor is significantly longer!!

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21
Q

______ help to ripen and dilate the cervix by causing dissolution of collagen bundles and increase water uptake by cells. What are 2 options?

A

prostaglandins

Cervidil –PGE2, vaginal
Cytotec – PGE1, vaginal or oral

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22
Q

What are the SE of prostaglandins used in the induction of labor? Give the 2 names

A

Cervidil –PGE2, vaginal
Cytotec – PGE1, vaginal or oral

Tachysystole, fever, vomiting, diarrhea
Uterine rupture

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23
Q

**What are the CI for prostaglandins?

A

History of cesarean section

myomectomy (peeling tissue from the uterus)

hysterotomy (incision into the uterus)

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24
Q

_____ is given which leads to induce labor by causing the uterus to contract. What is the identical version that is released from the posterior pituitary?

A

Pitocin

oxytocin

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25
Q

What are the SE of Pitocin?

A

Tachysystole - >5 contractions in 10 minutes

Uterine rupture (but not as likely as the prostaglandins)

Hyponatremia

Hypotension

Amniotic fluid embolism

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26
Q

What are the 2 CI of pitocin?

A

Fetal distress

hypersensitivity

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27
Q

What are the 3 non-medication options for induction of labor?

A

cervical ripening balloon

laminaria

artificial rupture of membranes using a hook

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28
Q

How does the laminaria work? Where else is it commonly used?

A

Rolled up seaweed that pulls out water and in turn dilates the cervix

used commonly in endometrium ablations

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29
Q

What are the 2 types of operative vaginal delivery? What are the indications?

A

forceps

vacuum

indications:
Prolonged second stage of labor
Maternal exhaustion
Hasten delivery for fetal compromise

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30
Q

What is the current rate of C-section in the US?

A

32.4%

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31
Q

What are the 4 stages of labor?

A
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32
Q

What does the Freidman’s curve represent?

A

Good guideline for expected progression in labor and helps to determine abnormal labor patterns

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33
Q

What does Zhang labor curve represent?

A

Labor progresses similarly for multips and primips until 6cm

active phase of labor starts at 6cm, after 6cm multiparas progress much quicker

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34
Q

How long is the first stage of labor for a nulliparous pt? multiparous?

A

Nulliparous patient: 10-12 hours

Multiparous patient: 6-8 hours

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35
Q

What are the 2 different phases of the first stage of labor?

A

latent and active

latent: From onset of labor with slow cervical dilation to ~6 cm. Slower phase

active: from 6cm to complete dilation 10cm with a faster rate of cervical change

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36
Q

What are the 3 P’s that factor into the active stage of labor?

A

Power – uterus
Passenger – fetus
Pelvis – baby has to fit out of

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37
Q

To assess power of uterine contraction, ______ can be used. To assess activity of contractions ______, _____ or ______ can be used

A

Intrauterine Pressure Catheter

observation of the mother
palpation of the fundus
external tocodynamometry

38
Q

What frequency is considered adequate labor? Give general and specific options

A

Generally 3-5 contractions in a 10 minute period is considered adequate labor

OR

Adequate labor > 200 Montevideo units in 10 min (must use IUPC to measure in Montevideo units)

39
Q

What are 4 different passenger variables that can affect labor?

A

macrosomia

fetus lying longitudinal, transverse or oblique

40
Q

What does a compound fetal presentation mean? Funic?

A

compound: something in front of the baby-arm

funic: umbilical cord

41
Q

if a baby is funic presentation, what should you do next?

A

go straight to C-section

42
Q

What is Leopolds maneuver? What 3 things make it harder?

A

abdominal palpation to determine
Fetal lie
Estimate fetal weight
Fetal position
Fetal presentation

Difficult if mother is obese, polyhydramnios or multifetal gestation

43
Q

Any position other than _____ usually results in a cesarean delivery. What is the weight cuttoff?

A

vertex

Fetus suspected to be greater than 5000 grams -> consider C section

DM: greater than 4500 grams -> consider C section

44
Q

Small pelvic outlet can result in _________ and can indicate _____

A

cephalopelvic disproportion

indicates cesarean delivery

45
Q

_____ is the ideal pelvic structure for having babies.

A

gynecoid

46
Q

What is the difference between labor protractions and labor arrest?

A

Labor protractions – labor progress that is slower than normal

Labor arrest – cessation of labor progress despite best attempts at augmentation

47
Q

What is active phase arrest of labor? What do you do next?

A

no progression in cervical dilation in patients who are at least 6-cm dilated with rupture of membranes despite 4 hours of adequate uterine activity or 6 hours of inadequate uterine activity with oxytocin augmentation

c-section

48
Q

What are the risk factors for umbilical cord prolapse? What do you do next?

A

Artifical rupture of membranes

Unengaged fetal head

C-section

49
Q

What is the second stage of labor defined by? What are 2 indications of the second stage?

A

Characterized by descent of the presenting part through the maternal pelvis and expulsion of the fetus

pelvic/rectal pressure
mother actively pushes

50
Q

What is molding?

A

Alteration of the fetal cranial bones to each other as a result of compressive forces of the maternal bony pelvis during labor

51
Q

What is considered an abnormal length of the second stage of labor? If the mom decides to keep pushing, this increases the risk of what 4 things?

A

more than 3 hours of pushing in nulliparous individuals and 2 hours of pushing in multiparous individuals

Neonatal acidemia
NICU admission
Third and fourth degree lacerations
Chorioamnionitis

52
Q

What are the different degrees of perineal lacerations?

A
53
Q

What are 5 complications of an episiotomy? What are the 2 variations of an episiotomy?

A

Increase vaginal bleeding

Increase postpartum pain

Unsatisfactory anatomic results

Sexual dysfunction

Increase risk of infection

midline and mediolateral

54
Q

What are maternal risk factors for shoulder dystocia?

A

Fetal macrosomia

Diabetes – overt and gestational

Previous shoulder dystocia

Maternal obesity

Postterm pregnancy

Prolonged second stage of labor

Operative vaginal delivery

55
Q

What are fetal risk factors for shoulder dystocia? How do you dx it?

A

Fracture of humerus and clavicle

Brachial plexus injuries

Phrenic nerve palsy

Hypoxic brain injury

Death

Made when routine delivery maneuvers fail to deliver the anterior shoulder

56
Q

What is McRobert’s maneuver? When is it used?

A

sharp flexion of maternal hips

for shoulder dystocia

57
Q

What is Zavanelli’s maneuver?

A

replace infants head back into the pelvis and do a c-section

58
Q

What are different options you could possibly do if a baby presents with shoulder dystocia?

A

Episiotomy
McRoberts maneuver – sharp flexion of maternal hips
Suprapubic pressure
Delivery of posterior shoulder
Symphisiotomy
Zavanelli

59
Q

What is the 3rd stage of labor? How long does it usually take?

A

The time from fetal delivery to delivery of the placenta

Usually about 30minutes

60
Q

What are 3 signs of placental separation?

A

Lengthening of umbilical cord

Gush of blood
Fundus becomes globular and more anteverted against abdominal hand

61
Q

How is the placenta delivered?

A

delivered using one hand on umbilical cord with gentle downward traction while the other hand on abdomen supporting the uterine fundus

62
Q

_______ is a risk factor if aggressive traction during delivery of the placenta

A

uterine inversion

63
Q

What 3 things need to be monitored closely during the 4th stage of labor?

A

Blood pressure, uterine blood loss and pulse rate must be monitored closely

64
Q

What are 3 causes that increase risk for postpartum hemorrhage? Which one is MC?

A

**Uterine atony –Most common cause

Retained placental fragments

Unrepaired lacerations of vagina, cervix or perineum

65
Q

What is considered a postpartum hemorrhage?

A

Blood loss >500c in a vaginal delivery or >1000cc in a cesarean delivery

66
Q

What is the tx for postpartum hemorrhage?

A

Removal of placental fragments or repair of lacerations

Additional IV access

Type and cross match for blood

Medications for uterine atony: Pitocin, Methergine, Cytotec, Hemabate

67
Q

What are the 7 cardinal movements of labor?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation/restitution
  7. Expulsion
68
Q

What is considered engagement? Descent?

A

Passage of the widest diameter fetal presenting part below the plane of the pelvic inlet. The head is said to be engaged if the leading edge is at the level of the ishial spines

Refers to the downward passage of the presenting part through the bony pelvis

69
Q

Describe what is happening during flexion? What part of the baby’s head has the smallest diameter?

A

Occurs passively as the head descends due to the shape of the bony pelvis

Complete flexion allows the fetal head’s smallest diameter to fit through the pelvis

subocciptobregmatic diameter

70
Q

What happens next after flexion?

A

internal rotation

Rotation of the fetal head from occiput transverse to occiput anterior or posterior position
Occurs passively due to the shape of the bony pelvis

71
Q

What is happening in the extension phase?

A

Occurs when the fetus has descended to the level of the vaginal introitus

When occiput is just past the level of the symphysis, the angle of the birth canal changes to upward position

72
Q

What is happening in external rotation/restitution?

A

As the head is delivered, it rotates back to its original position prior to internal rotation

Head aligns anatomically with the fetal torso

The release of the passive forces on the fetal head allows it to return to appropriate position

73
Q

Consider watching this video again, maybe?

A

https://www.youtube.com/watch?v=q1jmVN3ILpY

74
Q

what is a normal fetal heart rate? What is considered bradycardia?

A

110-160 bpm

Fetal HR less than 110

75
Q

What are 2 common causes of fetal bradycardia?

A

congenital heart block: mothers who have Lupus

maternal hypotension

76
Q

What is considered tachycardia in a fetus? What are 2 common causes?

A

fetal HR above 160bpm

infection
terbutaline

77
Q

How do you determine what a fetus’s baseline heart rate is? What about a fetus’s heart rate would make you worry?

A

Mean bpm over a 10 minute window

absence of variation and greater than 25 bpm of variation

some variation is normal!

78
Q

What is considered normal fetal heart rate accelerations that is a good thing?

A

> 32 weeks: at least 15bpm and lasting 15s

<32 weeks: at least 10bpm and lasting 10s

79
Q

What type of decelerations is normal and is completely fine? What will they look like when compared to the contractions? What is the tx?

A

Early decelerations

Begin and end approximately at the same time as contractions

no intervention required

80
Q

What type of decelerations is a problem? What will they look like when compared to the contractions? What is happen? What is the tx?

A

Late decelerations

Begin at peak of contraction and slowly return to baseline after the contraction has finished

Result of uteroplacental insufficiency (not enough reserve to keep the babies HR up during the contraction)

Position, Oxygen, Stop Pitocin, Check cervix, Fluid Bolus
Consider assisted delivery or cesarean delivery with more than 50% of the contractions

81
Q

If the FHR deceleration is due to cord compression, what should you do?

A

amnioinfusion of saline into the amniotic sac

82
Q

What type of deceleration?

A

early

dips are happening at the same time as contraction

HR is the top strip and contractions strip is on the bottom

83
Q

What type of deceleration?

A

early

84
Q

What type of deceleration?

A

late

85
Q

What type of deceleration?

A

late

contraction, then heart tone does down

86
Q

What type of deceleration?

A

variable

will look like “V” shaped

87
Q

What type of deceleration? What is the MC cause?

A

Sinusoidal

fetal anemia

VERY BAD!! need to delivery immediately

88
Q

What are the different categories of fetal heart rate tracings?

A
89
Q

What is the contraction stress test? What do you use? When do you preform this test?

A

Evaluates the fetal response to a transient reduction in fetal oxygen delivery during uterine contractions

Use pitocin to achieve 3 contractions in 10 minutes

Evaluate fetal status before induction of labor

90
Q

What is considered a positive (bad), equivocal or negative contraction stress test?

A
91
Q
A

Women's Health (6 decks)

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